Healthcare Provider Details

I. General information

NPI: 1700668779
Provider Name (Legal Business Name): PRIMARY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HIOAKS RD SUITE F/G
RICHMOND VA
23225
US

IV. Provider business mailing address

909 HIOAKS RD SUITE F/G
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 949-696-6157
  • Fax:
Mailing address:
  • Phone: 949-696-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID SHAHZAD
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-696-6157